Hepatocellular carcinoma (HCC) is a unique cancer entity that can be noninvasively diagnosed using imaging modalities without pathologic confirmation. In 2018, several major guidelines for HCC were updated to include hepatobiliary contrast agent magnetic resonance imaging (HBA-MRI) and contrast-enhanced ultrasound (CEUS) as major imaging modalities for HCC diagnosis. HBA-MRI enables the achievement of high sensitivity in HCC detection using the hepatobiliary phase (HBP). CEUS is another imaging modality with real-time imaging capability, and it is reported to be useful as a second-line modality to increase sensitivity without losing specificity for HCC diagnosis. However, until now, there is an unsolved discrepancy among guidelines on whether to accept “HBP hypointensity” as a definite diagnostic criterion for HCC or include CEUS in the diagnostic algorithm for HCC diagnosis. Furthermore, there is variability in terminology and inconsistencies in the definition of imaging findings among guidelines; therefore, there is an unmet need for the development of a standardized lexicon. In this article, we review the performance and limitations of HBA-MRI and CEUS after guideline updates in 2018 and briefly introduce some future aspects of imaging-based HCC diagnosis.
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The goal of this review is to present the similarities and differences among the latest guidelines for noninvasive diagnosis of hepatocellular carcinoma (HCC) of American Association for the Study of Liver Disease (AASLD), European Association for the Study of the Liver (EASL), Liver Imaging Reporting and Data System (LI-RADS), Asian Pacific Association for the Study of the Liver (APASL), and Korean Liver Cancer Association- National Cancer Center (KLCA-NCC) of Korea. In 2018, major guideline updates have been proposed by the AASLD, EASL and KLCA-NCC; AASLD newly incorporated LI-RADS into their HCC diagnostic algorithm. The AASLD and EASL guidelines now include magnetic resonance imaging (MRI) using hepatobiliary contrast media as a first-line diagnostic test in addition to dynamic computed tomography and MRI using extracellular contrast media and the KLCA-NCC and EASL guidelines also include contrast-enhanced ultrasound as a second-line diagnostic test. We will comprehensively review the HCC surveillance and diagnostic algorithms and compare and highlight key features for each guideline. We also address limitations of current systems for the noninvasive diagnosis of HCC.
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New boundaries of liver imaging: from morphology to function Manuel Cruz, Ana Aguiar Ferreira, Nikolaos Papanikolaou, Rajarshi Banerjee, Filipe Caseiro Alves European Journal of Internal Medicine.2020; 79: 12. CrossRef
Real-World Outcomes of Nivolumab in Patients With Unresectable Hepatocellular Carcinoma in an Endemic Area of Hepatitis B Virus Infection Pil Soo Sung, Jeong Won Jang, Jaejun Lee, Soon Kyu Lee, Hae Lim Lee, Hyun Yang, Hee Chul Nam, Sung Won Lee, Si Hyun Bae, Jong Young Choi, Nam Ik Han, Seung Kew Yoon Frontiers in Oncology.2020;[Epub] CrossRef
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Validation of the Korean Liver Cancer Association-National Cancer Center 2018 Criteria for the Noninvasive Diagnosis of Hepatocellular Carcinoma Using Magnetic Resonance Imaging Sunyoung Lee, Myeong-Jin Kim Journal of Liver Cancer.2020; 20(2): 120. CrossRef
Infiltration of T Cells and Programmed Cell Death Ligand 1-expressing Macrophages as a Potential Predictor of Lenvatinib Response in Hepatocellular Carcinoma Pil Soo Sung, Sung Woo Cho, Jaejun Lee, Hyun Yang, Jeong Won Jang, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon Journal of Liver Cancer.2020; 20(2): 128. CrossRef
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The Modified Response Evaluation Criteria in Solid Tumors (RECIST) Yield a More Accurate Prognoses Than the RECIST 1.1 in Hepatocellular Carcinoma Treated with Transarterial Radioembolization Jae Seung Lee, Hong Jun Choi, Beom Kyung Kim, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Song-Ee Baek, Yong Eun Chung, Mi-Suk Park, Myeong-Jin Kim, Hyungjin Rhee, Seung Up Kim Gut and Liver.2020; 14(6): 765. CrossRef
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Appraisal of Long-Term Outcomes of Liver-Directed Concurrent Chemoradiotherapy for Hepatocellular Carcinoma with Major Portal Vein Invasion
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A Real-World Comparative Analysis of Lenvatinib and Sorafenib as a Salvage Therapy for Transarterial Treatments in Unresectable HCC Jaejun Lee, Pil Soo Sung, Hyun Yang, Soon Kyu Lee, Hee Chul Nam, Sun Hong Yoo, Hae Lim Lee, Hee Yeon Kim, Sung Won Lee, Jung Hyun Kwon, Jeong Won Jang, Chang Wook Kim, Soon Woo Nam, Si Hyun Bae, Jong Young Choi, Seung Kew Yoon Journal of Clinical Medicine.2020; 9(12): 4121. CrossRef
Circulating Exosomal MicroRNA-1307-5p as a Predictor for Metastasis in Patients with Hepatocellular Carcinoma Jung Woo Eun, Chul Won Seo, Geum Ok Baek, Moon Gyeong Yoon, Hye Ri Ahn, Ju A. Son, Suna Sung, Do Wan Kim, Soon Sun Kim, Hyo Jung Cho, Jae Youn Cheong Cancers.2020; 12(12): 3819. CrossRef
A New Diagnostic Criterion with Gadoxetic Acid-Enhanced MRI May Improve the Diagnostic Performance for Hepatocellular Carcinoma Yi Wei, Zheng Ye, Yuan Yuan, Zixing Huang, Xiaocheng Wei, Tong Zhang, Shang Wan, Hehan Tang, Xiaopeng He, Bin Song Liver Cancer.2020; 9(4): 414. CrossRef
Hepatocellular Carcinoma Risk Steadily Persists over Time Despite Long-Term Antiviral Therapy for Hepatitis B: A Multicenter Study Seung Up Kim, Yeon Seok Seo, Han Ah Lee, Mi Na Kim, Eun Ju Lee, Hye Jung Shin, Yu Rim Lee, Hye Won Lee, Jun Yong Park, Do Young Kim, Sang Hoon Ahn, Kwang-Hyub Han, Soon Ho Um, Won Young Tak, Young Oh Kweon, Beom Kyung Kim, Soo Young Park Cancer Epidemiology, Biomarkers & Prevention.2020; 29(4): 832. CrossRef
Cone-Beam CT–Guided Chemoembolization in Patients with Complete Response after Previous Chemoembolization but Subsequent Elevated α-Fetoprotein without Overt Hepatocellular Carcinoma Tunyarat Wattanasatesiri, Hyo-Cheol Kim, Jin Woo Choi, Jeong-Hoon Lee, Ijin Joo, Saebeom Hur, Myungsu Lee, Hwan Jun Jae, Jin Wook Chung Journal of Vascular and Interventional Radiology.2019; 30(8): 1273. CrossRef
LI-RADS Version 2017 versus Version 2018: Diagnosis of Hepatocellular Carcinoma on Gadoxetate Disodium–enhanced MRI Sang Min Lee, Jeong Min Lee, Su Joa Ahn, Hyo-Jin Kang, Hyun Kyung Yang, Jeong Hee Yoon Radiology.2019; 292(3): 655. CrossRef
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